Sports Medicine Research: In the Lab & In the Field: Hypertension Among Collegiate Football Athletes – Too Much Pressure? (Sports Med Res)
Friday, January 3, 2014

Hypertension Among Collegiate Football Athletes – Too Much Pressure?

High Prevalence of Hypertension Among Collegiate Football Athletes

Karpinos AR, Roumie CL, Nian H, Diamond AB, Rothman RL. Circ Cardiovasc Qual Outcomes.  2013;6:00-00.

Take Home Message:  College football athletes may have a higher prevalence of hypertension than college male nonfootball athletes. 

Routine physical activity is an established means of reducing blood pressure; however, a recent study of National Football League players found that they had a higher prevalence of hypertension compared with the general population – 14% versus 6%.  It is challenging to know if these findings are applicable to college football athletes because there is limited research in this area. Therefore, Karpinos and colleagues conducted a retrospective cohort study to determine the prevalence of hypertension among collegiate football athletes compared with nonfootball male athletes.  The authors reviewed the medical charts (1999-2012) of 636 male athletes from a Southeastern Conference Division I university, which included 323 football athletes and 313 nonfootball athletes.  Data collected included blood pressure, body mass index, medication use, and supplement use in the initial through final years of participation.  The authors excluded athletes if they had a history of cardiac or renal abnormality or surgery, no preparticipation physical evaluation records, or no initial blood pressure collected.  Blood pressure classifications from Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) were used: 1) Normal blood pressure = systolic below 120 mmHg and diastolic below 80 mmHg, 2) Prehypertension = systolic of 120-139 mmHg or diastolic of 80-89 mmHg, and 3) hypertension = systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg, history of hypertension, or use of an antihypertensive medication.  The authors found that football players were more likely to be black, have a higher initial body mass index, and parental history of hypertension. Overall, 19% of football athletes had hypertension in both their initial and final years of participation, which was higher than the nonfootball athletes - 7% and 10%. The authors also found that 76% of all male athletes had prehypertension or hypertension.

The authors found similar results compared to previous smaller studies of hypertension among college football athletes – 23.5% and 14%. The authors noted that a limitation to their study is that they focused on one school, but if this data is accurate, male college athletes may have an increased cardiovascular risk that should be followed more closely.  This elevated blood pressure could be due to multiple factors, such as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), high salt intake, strength and resistance training, the pressure of competition, stimulant use, supplement use, increased body mass index, or race.  The authors also question whether the current guidelines of hypertension for the general population can be applied to the athletes.  Can the high blood pressure be explained by the football players having a higher body mass index than nonfootball players, or is their body mass index overestimated due to increased muscle mass? Once a high blood pressure reading is identified, a follow-up plan should be made to repeat the blood pressure in several weeks.  Ideally, this should be done when all factors for an elevated reading are eliminated, such as the athlete having just finished a workout or a caffeinated beverage, or using NSAIDs.  By educating athletes at a young age regarding their cardiovascular health, hopefully this can carry over to their adult years.  Further research may help us define the significance of hypertension in a athletic population and how to optimally manage it in the university setting.

Questions for Discussion: What programs do you have at your university to monitor blood pressure in your athletes?  What patient education or advice do you provide to these athletes?

Written by: Kris Fayock, MD
Reviewed by: Jeffrey Driban

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Karpinos AR, Roumie CL, Nian H, Diamond AB, & Rothman RL (2013). High prevalence of hypertension among collegiate football athletes. Circulation. Cardiovascular Quality and Outcomes, 6 (6), 716-23 PMID: 24221829

2 comments:

Lola Smith said...

Hey, I appreciated you writing.Just i'd to like to shear a few point with you,Considering the notoriety of football in the United States, I accept this information of a relationship with upgraded commonness of prehypertension and stage 1 hypertension after one season in a few players is greatly critical," said American Heart Association representative Ernesto Schiffrin, M.d., Ph.d., who is not associated with the study. "Notwithstanding, the study ought not be translated to imply that playing football causes hypertension. Rather, it recommends expanded observation especially in those most powerless: those with a family history of hypertension or playing in all out attack mode or guarding line.Thank you!!!
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Charles Weber said...

For a long time it has been assumed that it was the sodium in salt that contributed to high blood pressure. Experiments with potassium chloride supplements show that such supplements often raise blood pressure, as covered in this URL; http://www.ucop.edu/sciencetoday/pages/archive/transcripts/2000/sci616.html#D . Now it is known that sodium must be combined with chloride to raise blood pressure. Sodium alone causes blood pressure to fall in salt sensitive people. [McCarty 2004 Medical Hypotheses 63; 138-148]. Sodium bicarbonate lowered blood pressure 5 mm of mercury [Luft FC Zemel MB Sowers JA Fineberg NS Weinberger MH 1990 Journal of Hypertension 8; 663-670], perhaps so little because the subjects were probably already on high salt intake Also see; [Boegshold M Kotchen TA 1991 Hypertension 17 (suppl) I 158-I161]. This must be intimately involved with pH regulation in some way, because adding sodium bicarbonate to potassium chloride neutralizes the affect of potassium chloride on pressure [McCarty]. This should have the same net affect as adding a sodium chloride supplement to a normal diet high in potassium. It has been known for a long time that higher potassium to sodium molar ratios have an inhibiting affect on blood pressure from salt hypertension [Dahl, et al 1972 I Journal of Experimental Medicine 136; 318-330]. See also http://www.wellnessresources.com/tips/articles/potassium_is_a_vital_key_for_lowering_blood_pressure/ The link to pH regulation is plausible because 18 OH-DOC is deeply involved in one of the, at least three, forms of hypertension [Melby JC et al 1972 Recent Progress in Hormone Research. 28; 287-351, on page 323] and 18OH-DOC is probably the steroid hormone that regulates hydrogen ion excretion [see; http://charles_w.tripod.com/electrolyte.html ]There is no significant increased risk of cardiovascular disease statistically for serum potassium between 4.1 and 5.3 Meq per liter (4.8 is what the body aims for), but the incidence of hypertension is 3% in a 4.1 meq average, to 2% in a 4.5 meq average, to 1% in 4.8 meq average or 5.1 meq average [Walsh, et al 2002 Archives of Internal Medicine 162; (9) 1007-1012].
With at least three different forms of high blood pressure, as above, and all the other nutrients wildly varying in people’s diet, the situation is hopelessly complicated. But in so far as potassium being involved is concerned, supplements are not normally the way to go as a rule. Anyone should get as much potassium as possible from food. The reason is that you tend to avoid the possibility of imbalances or deficiencies with other nutrients. This is especially important with respect to magnesium since potassium is absorbed with difficulty in a magnesium deficiency, and a magnesium deficiency takes months to correct. The imbalance that can be most immediately dangerous is the interaction with thiamin (vitamin B-1) because heart disease can not occur when both are deficient [see; http://charles_w.tripod.com/kandthiamin.html ].
The main important aspect of potassium, though, is to avoid heart attacks. High blood pressure is unlikely to cause a ruptured blood vessel in the presence of adequate copper [see http://charles_w.tripod.com/copper3.html ] and vitamin C, since healthy blood vessels are normally ten times as strong as they have to be to stand normal pressures. Heart involvement does not usually come from potassium unless the blood content sinks below 4.0 meq per liter at least. What really counts is the cell potassium content, and the only practical way that I know of to determine that is a whole body scintillation counter coupled with a fat content analyzer. So it is imperative to get more than enough potassium in food or supplements since such machines are rarely available. 3500 milligrams per day total would be ideal.

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